AHCCCS Update Meeting – Systems Update September 2015

Topics: ICD10 Project Wrap-up/Reminders Greater AZ SMI Integration Wrap-up/Reminders GMH/SA Duals Integration Wrap-up/Reminders FQHC/RHC Project Updates – Open Issues/Challenges PCP Rate Parity Project Updates AHCCCS CRN Expansion Project (999 Lines) Updates 2 Reaching across Arizona to provide comprehensive quality health care for those in need

ICD10 Project Wrap-up/Reminders ICD10 Effective Date - October (OP Dates of Services or IP Dates of Discharge); no exceptions Testing with Trading Partners began in January of 2014 and will continue through September of 2015 (or ongoing as needed) We have received a high volume of questions from providers as well as requests for testing in the last 30 days AHCCCS supplied a limited set of required Testing Scenarios that all Contractors had to successfully complete prior to implementation 3 Reaching across Arizona to provide comprehensive quality health care for those in need

ICD10 Project Wrap-up/Reminders, cont. AHCCCS will be running a standard set of monitoring reports post 10/1/2015 for Claims and Encounters to assess and make early identification of any areas of issue If fully implemented MCO Milestone reporting will cease after the 10/15 reporting for this project Beginning 10/1/15 MCO’s will be asked to supply a limited set of every other week updates on key areas, more information to be distributed this week 4 Reaching across Arizona to provide comprehensive quality health care for those in need

Greater AZ SMI Integration Wrap- up/Reminders ADHS/BHS awarded two contracts one for southern AZ GSA’s (Cenpatico Integrated Care - Health Plan ID ; Site Codes 39 & 79) and one for northern AZ GSA’s (Health Choice Integrated Care – Health Plan ID ; Site Codes 38 & 78) to serve as Integrated Contractors (providing both behavioral and physical health services to SMI members) and the RBHA for all other members in these GSA’s AHCCCS required systems changes and conversion programs to support this implementation will be in place for 10/1/ Reaching across Arizona to provide comprehensive quality health care for those in need

Greater AZ SMI Integration Wrap- up/Reminders, cont. Walkthrough of AHCCCS Implementation/Go Live Plan scheduled for next week with each Contractors Key Contacts Clarification of Opt-Out o Allowed only with cause; initiated by member o Specific reasons for opt out with be tracked and reported to CMS o Opt Out only impacts “Enrollment Rules”; member will remain with a SMI BH Category, but will not be enrolled in an Integrated RHBA and will instead follow regular Non-Integrated “Enrollment Rules” 6 Reaching across Arizona to provide comprehensive quality health care for those in need

GMH/SA Duals Integration Wrap- up/Reminders Medicare/Medicaid dual eligible General Mental Health (GMH)/Substance Abuse (SA) members will be assign their enrolled AHCCCS Health Plan to provide both their physical and behavioral health services (New BH site codes – 50, 51, 52, 53, 54, 55, 56 & 57) AHCCCS required systems changes and conversion programs to support this implementation will be in place for 10/1/2015 Walkthrough of AHCCCS Implementation/Go Live Plan scheduled for next week with each Contractors Key Contacts 7 Reaching across Arizona to provide comprehensive quality health care for those in need

FQHC/RHC Project Updates – Open Issues/Challenges FQHC/RHC Payment Alignment policy and processes put in place for dates of service 4/1/15 and after to pay FQHC/RHC provider specific PPS rates for each “visit” With this implementation challenges were identified related to MIHS; updates/changes in progress to support MIHS specific needs ASAP by AHCCCS and all Contractors Recently an concern regarding requirements related to the Participating Practitioner was posed by Dental Quest; meeting this week to assess 8 Reaching across Arizona to provide comprehensive quality health care for those in need

PCP Rate Parity 9 Reaching across Arizona to provide comprehensive quality health care for those in need Adjudication DatesRun Date August - December 2013Completed January - March 2014Completed April - June 2014Completed July - September 2014 *Completed October 2014Completed November 2014Completed December 2014Completed January - March 2015Completed April – June 2015 (includes July 2014 –June 2015 Void/Replace)Distributed July 21, 2015 April – June 2015 (includes July 2014 –June 2015 Void/Replace) - RerunDistributed August 28, 2015

PCP Rate Parity (cont.) Contractor Error Reports in sample or full may be made available to plans as requested In the event that a provider is subsequently “decertified” for enhanced payments as result of required audits or other changes to providers: o Contractors will be required to reprocess all impacted claims for recoupment of enhanced payment amounts and replace encounters for the reprocessed claims o Contractors will be required to refund payments to AHCCCS for any reduced claim payments 10 Reaching across Arizona to provide comprehensive quality health care for those in need

PCP Rate Parity (cont.) The first of the required audits of eligible providers is currently nearing completion pending receipt of a few identified outstanding records and final assessment of provider Future cost settlements will include only dates of service on and after 10/1/13 other than by specific exception 11 Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCS CRN Expansion Project (999 Lines) AHCCCS 999 UB Lines HIPAA compliance changes Targeted for a March 2016 Implementation Fully remediated the PMMIS system to expand the CRN by 1 additional digit for all form types; i.e.… AHCCCS CRN’s will go from 14 digits to 15 digits in length Impacts all processes, reporting, PMMIS screens, etc… that utilize CRN’s from the implementation date forward Will impact and require testing with Contractors and Trading Partners 12 Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCS CRN Expansion Project (999 Lines), cont. Testing to begin ASAP after 10/1/15 and CRN expansion will be reflected in the AHCCCS PMMIS Test System after this week Technical Workgroup to be schedule to review specific project details and areas of impact ASAP 13 Reaching across Arizona to provide comprehensive quality health care for those in need

Questions? 14 Reaching across Arizona to provide comprehensive quality health care for those in need

Thank You. 15 Reaching across Arizona to provide comprehensive quality health care for those in need